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Bone-Maintenance Drugs continued...

If someone who's been taking a bisphosphonate for a long time has that rare type of thigh bone fracture, their doctor should switch them to another type of osteoporosis drug, Deal says.

The following drugs are among the alternatives to bisphosphonates for either treating or preventing osteoporosis:

  • denosumab (Prolia). This is a biologic drug that slows bone loss.
  • raloxifene (Evista)
  • teriparatide (Forteo). This is a type of parathyroid hormone that increases bone formation.
  • Hormone replacement therapy

If you've been taking a bisphosphonate for five years, Deal says your doctor may check to see whether you should continue, stop, or switch to another bone-maintenance drug.

Hormone replacement therapy (HRT) -- either estrogen alone or a combination of estrogen and progestin -- used to be prescribed for the prevention and treatment of osteoporosis. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. Duavee may also prevent osteoporosis in high-risk women who have already tried non-estrogen treatment. 

Research has shown that hormone replacement therapy increases the risk of breast cancer, heart disease, and stroke in some women. So while HRT is known to help preserve bone and prevent fractures, it isn't generally recommended at this point for treating osteoporosis because the health risks are thought to outweigh the benefits.

In women who have been on menopausal hormone therapy in the past and then stopped taking it, the bones begin to thin again -- at the same pace as during menopause.


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